Your podiatrist/chiropodist has diagnosed that you have a deformity of one or more of your toenails. The most common deformities are excessively curved or wide nail plate, predisposing it to grow into the skin at the side of the nail, or a thickened toe nail. Whilst conservative treatment can help to prevent pain or infection, this will not cure the problem. In order to correct the deformity you may require an operation, which will be recommended if you have a significant problem or frequent episodes of infection. Answers to common questions are outlined in this information page.
Before undertaking surgery you should be certain that conservative (non-surgical) options have been considered and that you fully understand the implications and possible but rare complications of the proposed surgery. If you have any concerns please discuss these with your podiatrist/chiropodist before the operation date.
At Stockport Chiropody clinic we pride ourselves on our ethical approach to nail surgery. All our clinicians consider themselves specialists in conservative management of ingrowing nails. A huge proportion of our daily clinics involve management and treatment of the condition. Therefore if Matthew, Caroline or Helen suggest that nail surgery is now required, it means that conservative management is now no longer enough and is not acceptable to the patient, and that nail surgery will now have to be considered.
How will we correct the deformity?
Whilst removing the nail will resolve the current problem, the nail will grow back and it is likely that you will be left with the same problem. In order to prevent the nail from regrowing , the troublesome section of nail will be removed and a strong chemical, Phenol, is applied to prevent the nail from re-growing. In the vast majority of patients we only need to remove a small section at one or both sides of the nail (partial nail avulsion). This leaves you with a slightly narrower nail plate but without the troublesome section. In some instances, the whole nail needs removing (total nail avulsion). In this case, there will be no further nail growth.
If an ingrowing toenail has been present for sometime, there is often a build up of excess tissue that often bleeds easily this usually looks very red, sore and swollen. This know as hypergranulation tissue and is an over reaction to the irritation and/ or infection. This is sometimes removed during the procedure, however it is usually left alone to shrink back after the troublesome nail has been removed.
What will happen during the operation?
The operation will be performed under local anaesthetic, so you are awake and can eat normally up until the time of your operation. The injection is given at the base of the affected toes and is very similar to a dental injection. The actual procedure will last only 10-15 minutes, but the whole appointment usually lasts around and hour, to allow for sufficient preparation and post operative monitoring. Full written consent is required before and procedure can happen. Dressings will be applied to the toe. A dressing pack will be given to the patient. Once the patient has been discharged from the clinic is is there personal responsibility to look after the surgical wound and manage the dressings accordingly. It is advised to wear a sandal after operation, and we strongly advise that someone else drives home, as your car insurance will not cover you if you have a numb toe/foot and are involved in an incident.
What are the advantages of this operation?
- Less discomfort.
- No or reduced episodes of infection.
- Easier mobility.
- More choice of footwear.
- Generally happier foot health.
Whilst it cannot be guaranteed that you will never have another problem with the toe or be completely pain free, it is highly likely that your toe will be much improved.
I have heard it is a very painful operation.
Recent advances in local anaesthetics techniques and modern pain relief now mean that patients have a high level of success with much less pain. In general there is very little discomfort the night of the operation or the healing period. If the patient wears sensible footwear this speeds up recovery and reduces post op pain. It is very rare that the level of pain is not controlled by normal pain relief tablets (e.g. Paracetamol or Nuerofen).
What are the potential complications?
Every effort is made to minimise the risk of complications and these are rare. However rare these may be, some complications sometimes happen.
-Prolonged weeping (See recovery below).
-Infection, this can sometimes occur during recovery in the area where the nail has been removed, sometimes antibiotics may have to be prescribed. In reality this is rare as the operation is often performed due to recurrent infected ingrowing nails. Infection is less likely to occur once the offending piece of nail has been removed.
-A reaction to the Phenol (phenol flare) can occur but this is rare and will be dealt with if necessary (less than 1%).
-Re-growth of the affected nail. This occurs in approximately 5-8% of patients undergoing partial nail avulsion and 10% of those undergoing total nail avulsion. However if re-growth does occur it is often less troublesome than the original problem. The procedure can be repeated if needed. It must be stated that this is no fault of the podiatrist/chiropodist,and unfortunately sometimes happens, it appears some individuals have super healing cells that phenol didn’t destroy.
-In rare cases a small section of nail can re-grow beneath the skin at the base of the nail (less than 0.5%). This can form a small cyst, which requires excision.
-Blood clotting (thrombosis) in the deep veins of the leg (0.5%) can occurs with any operation. This condition can result in a small piece of clot dislodging (embolism) and going to the lung (pulmonary embolism). This is extremely rare with this type of operation, as you remain mobile. However if it does occur, it is potentially life threatening condition.
Although all these complications are possible they are infrequent. Please be sure to discuss any areas of concern with your podiatrist/chiropodist, and discuss any concerns that you have about the procedure. It must also be stated that this operation is carried out on a regular basis, the techniques used have been the same for decades, therefore it is generally a safe and successful minor procedure.
How long will it take for me to recover.
On the first night, you should not drive following the operation. We advise you to arrange a lift or get a taxi from the clinic after the procedure. After most minor surgical procedures it is generally advised to rest on the first night and take pain killers if necessary.
During the first week a strict regimen of dressing the wound (toe) required. This is because the application of phenol to destroy the nail bed causes a chemical burn, which takes time to heal. However healing time can be improved by following simple guidelines on dressing technique. It may be necessary to bathe the wound in warm salt water twice daily from the day after the operation. It is strongly advised to keep the toe covered at all times with a sterile dressing to keep it clean and minimise the risk of infection. You will be able to walk/work but sensible footwear is advised and sport or strenuous exercise is not recommended. If problems present you may be seen again at the clinic.
Between 2-6 weeks following the procedure.
You need to keep dressing the toe until it stops weeping, usually when it becomes a bit dry and crusty and a healthy looking pinkish colour. This usually takes on average 4-6 weeks. Please note that once the operation has taken place it is the patients responsibility to look after and maintain good dressing technique, if complications arise due to poor dressings, recovery will ultimately be delayed, for example not wearing a sterile dressing at all times.